Facelift 12
The patient is a 67 year old woman who came to her consultation and noted that her face seemed to have “deflated” and was sagging and she wanted to have facial plastic surgery including a face lift with a neck lift and laser treatment for wrinkles. She had consulted with several eyelid surgeons but was still unsure whether she could benefit more from having an “eyelid lift” or a brow lift. She wanted a best overall plan for her facial anatomy and needs.
Her treatment plan included a facelift with a neck lift (platysmaplasty), a brow lift (without hairline lowering surgery or a change in the hair line), and laser resurfacing for the wrinkles of the eyelids, Crow’s foot areas, cheeks and around the mouth. She recovered quickly from her cosmetic surgery and was walking outside the following morning. The laser treated skin was healed and dry by the sixth day after her plastic surgery procedure and makeup begun by the eighth day after the procedure. By the end of the tenth day most of the swelling was gone and she was back to most of her activities. The patient was very happy that she was free to discuss what was bothering her at her initial consult and that she ultimately had her procedure by a plastic surgeon who could take a complete view and formulate a plan to achieve overall facial harmony and not see just part of the issues.
When face lifts are performed with the neck lift and browlift, even lifting results with a youthful and glowing appearance as can be seen in the facelift surgery before and after pictures. Adding laser skin resurfacing to lifting procedures also helps to create harmony as it’s unusual to see women without skin laxity who have wrinkles. It is interesting that though laser skin resurfacing is great at wrinkle removal, facelifts themselves also treat wrinkles besides tightening loose skin. In fact, face lifts are also known as “rhytidectomies”, or wrinkle removal surgeries. This term was more in vogue in the distant past when there were no other means to remove wrinkles. Since then, the laser has become the work-horse for facial wrinkles and is highly effective in their treatment. It’s very important to know what certain procedures are able to do and what they are not able to achieve. Regarding tightening of the skin, the laser by itself can tighten the skin about the lids but not over the cheek and it is in this area that the face lift takes over to both remove folds and wrinkles in the cheek.
Cheek lifting is a major priority during face lifting and helps to not only soften the deep folds adjacent to the nose and mouth but also elevates the sagging tissue and restored it to its original youthful position over the cheekbone. In this fashion a young “look” results which harmonizes with the smooth skin from the laser and the resolution of folded skin as the result of the facelift.
The patient was very elated at the results of her brow lift and she was happy that she had a browlift rather than having cosmetic eyelid surgery. The lift was able to expand the space between her eyelash line and the brow and so restored the facial proportion of this space to the rest of the face as well as other spaces and just seems to “go” with the rest of the face. The brow lift was able to resolve the hooded appearance too and it’s much easier for the patient to wear and apply makeup. Upper eyelid surgery by itself might have caused the space between her brow and eyelash line to become even smaller and possibly appear less youthful.
The neck lift portion helps the face lift to define the jaw line and angle of the jaw as well, the part of the jaw that is in front of the ear as can be seen in the patient’s neck lift photos. The neck, now smoothed and squared appears youthful within itself and creates harmony with the face. The necklift includes treatment of the fine muscle just under the skin called the platysma whose function is to crinkle and shorten the skin of the neck. As we age, the platysma shortens from the top to the bottom and this makes these muscles stick out in some patients near the midline of the neck. Since this muscle is used a lot in communication and during chewing, this constant muscle activity cause the overlying neck skin to become loose and even folded. Therefore, treatment of the platysma muscle is key to a successful neck lift. During a platysmaplasty, face surgeons can release and therefore lengthen the muscle and repair the platysma so that it can no longer damage the overlying skin and no longer accelerate the process of facial aging.
Treating the face as an entire entity, a whole, can be very beneficial for patients who seek facial rejuvenation and want, not only to look younger but more natural and this allows the natural beauty of the patient’s face to shine through.